NPI 1265450464

Gordon Keith Green, DDS

Practitioner General Practice Dentistry Lyons, IN

Practice location

Address: 147 E Broad St, Lyons, IN 47443-9502
Phone: (812) 659-2111
Fax: (812) 659-2808
Mailing address: P O Box 501 147 East Broad St, Lyons, IN 47443-9502

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 7342 (IN)

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Registry record

NPI: 1265450464
Entity type: Individual
Sex (as registered): Male
NPI issued: 17 Jul 2006
Record last updated: 17 Dec 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.